Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2023; 11(1): 143-149
Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.143
Devastating complication of negative pressure wound therapy after deep inferior epigastric perforator free flap surgery: A case report
SooA Lim, Dong Yun Lee, BumSik Kim, Jung Soo Yoon, Yea Sik Han, SuRak Eo
SooA Lim, Dong Yun Lee, BumSik Kim, Jung Soo Yoon, Yea Sik Han, SuRak Eo, Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, GoYang 10326, South Korea
Author contributions: Lim SA, Lee DY, and Eo SR wrote the first draft of the manuscript; All authors reviewed and edited the manuscript and approved the final version of the manuscript.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: SuRak Eo, MD, PhD, Doctor, Professor, Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, Dongguk-ro 27, IlSanDong-gu, GoYang 10326, South Korea. sreodoc@gmail.com
Received: August 12, 2022
Peer-review started: August 12, 2022
First decision: October 12, 2022
Revised: November 1, 2022
Accepted: December 9, 2022
Article in press: December 9, 2022
Published online: January 6, 2023
Processing time: 145 Days and 17.7 Hours
Abstract
BACKGROUND

Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence. They require immediate and appropriate management before they progress to an irreversible condition. Although negative pressure wound therapy (NPWT) can prevent wound progression by increasing microcirculation, the inappropriate application of NPWT on complication-threatened transferred and replanted tissues can induce an adverse effect.

CASE SUMMARY

A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap. While applying a heating pad directly to the flap site, she sustained a deep second to third-degree contact burn over 30% of the transferred flap on postoperative 7 d. As the necrotic changes had progressed, we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d. After 4 d of NPWT application, the exposed fatty tissues of the flap changed to dry and brown-colored necrotic tissues. Upon further debridement, we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.

CONCLUSION

Although NPWT has been shown to be successful for treating various wound types, the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.

Keywords: Negative Pressure Wound Therapy; Complications; Breast reconstruction; Deep inferior epigastric artery perforator; Free flap; Burn injury; Case report

Core Tip: Negative pressure wound therapy (NPWT) is the effective promotion of survival in free tissue transfer, but special attention is required in cases of burn injury over the transferred flap site. Microsurgeons should be cautious about location of the pedicle, pressure and mode when using NPWT at burned site over transferred free flap tissue.